Introduction
Extra-nodal marginal zone lymphoma (MZL) of MALT type compose 7% of all non-Hodgkin’s lymphomas.1 Approximately one-third present as a primary gastric lymphoma; 90% are associated withHelicobacter pylori (H. pylori ).1,2 The etiology of H. pylori negative lymphoma of MALT type remain controversial. Differentiating H. pylori negative from H. pylori lymphoma of MALT type is important in regards to treatment and prognosis. The incidence of primary MALT lymphoma of the gastric remnant or gastric pouch is not well defined but appears to be quite rare with less than 35 cases reported worldwide. In this case report, we discuss the suspected etiologies, diagnosis, treatment, and outcome of a 36-year-old female found to have H. pylori negative gastric lymphoma of MALT type. The case is further complicated by history of Roux-en-Y gastric bypass (RYGB) for treatment of refractory gastroesophageal reflux disease (GERD).